Senior Provider Reimbursement Professional (MCCAU Coded Policy Team)
About the position
The Senior Provider Reimbursement Professional plays a crucial role in the health insurance sector by conducting research, analysis, documentation, and interpretation of provider reimbursement programs. This position involves handling moderately complex to complex issues, requiring a thorough evaluation of various factors. The professional is responsible for updating, maintaining, and reviewing fee schedules and pricing structures, ensuring that contracted rates and reimbursement policies are accurately priced and applied. Additionally, the role involves identifying recommendations for reimbursement policies and processes while ensuring compliance with government regulations. The Senior Provider Reimbursement Professional analyzes provider reimbursement patterns and trends, beginning to influence the department's strategy. This position requires making decisions on moderately complex to complex issues regarding the technical approach for project components, with work performed independently and considerable latitude in determining objectives and approaches to assignments.
Responsibilities
Perform research and analysis for provider reimbursement programs.
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Update and maintain fee scheduling and pricing structures.
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Ensure accuracy in contracted rates and reimbursement policies.
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Identify recommendations for reimbursement policy and process improvements.
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Ensure compliance with government regulations regarding reimbursement.
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Analyze provider reimbursement patterns and trends.
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Influence department strategy based on analysis and findings.
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Make decisions on complex issues regarding project components.
Requirements
2 years of coding certification or equivalent from PHIA, AAPC, and/or AHIMA.
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Extensive knowledge of medical claims processing and reimbursement methodologies.
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Familiarity with ICD, CPT, and HCPCS coding systems.
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Experience in medical code editing.
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Comprehensive knowledge of Microsoft Word, Outlook, and Excel.
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Strong attention to detail and excellent time management skills.
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Ability to work independently and as part of a team.
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Passion for improving consumer experiences.
Nice-to-haves
BS in healthcare or business-related field.
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Knowledge of internal Medical Coverage Policies and Claims Payment Policies.
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Experience with Metavance and CAS claims processing.
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Previous supervisory or team lead experience.
Benefits
Medical, dental, and vision benefits.
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401(k) retirement savings plan.
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Paid time off including company and personal holidays.
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Volunteer time off.
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Paid parental and caregiver leave.
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Short-term and long-term disability insurance.
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Life insurance.
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Bonus incentive plan based on performance.
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